OB/GYN ER elective for 3rd yr med student

[SanDiegoSOD]

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Hi folks, 3rd year medical student here, hoping for some advice on my elective situation. I'm going to schedule an elective rotation for this coming "winter break" in Dec-Jan. I have a strong interest in EM and I'd like to get into the ER so I can get a taste of what the specialty is really like; the only way I can do so is through an OB/GYN ER rotation, where I'd be based full time in the ER and be the consult or first contact for any obgyn related patients. I'd like to use the time to get to know some EM faculty and to to see if EM is really as great as I build it up to be in my mind.
So the question is, is this a bad idea? At the time I'll only have taken Psych, OB/GYN and Pediatrics, so I won't have the knowledge of a 4th year med student who has taken medicine and surgery. Are there other downsides to doing this rotation (other than countless spec exams 😱)? Your thoughts are appreciated 👍

 

[Wrigleyville]

The downside is the marginal amount you would learn, already having taken OB/Gyn, where you would likely already have learned much of the ER OB stuff. Also, as you have stated, I don't think you will get the full appreciation for ER work in general until you've had medicine and surgery. I'd schedule ER first thing 4th year.

 

[Toohotinvegas33]

Hi folks, 3rd year medical student here, hoping for some advice on my elective situation. I'm going to schedule an elective rotation for this coming "winter break" in Dec-Jan. I have a strong interest in EM and I'd like to get into the ER so I can get a taste of what the specialty is really like; the only way I can do so is through an OB/GYN ER rotation, where I'd be based full time in the ER and be the consult or first contact for any obgyn related patients. I'd like to use the time to get to 👍

This might just be me, but that sounds like hell. Kind of like doing trauma surgery as your first rotation third year.

 

[jbar]

I'd only do it if you like doing OB/GYN all day. Otherwise it'd be a long rotation. Does ortho have a trauma service at your hospital? I'm starting ortho trauma next week and hear it's a lot of ED consults, and i'd rather be doing ortho than OB all day.

 

[docB]

I would be careful trying to any rotation just because you think it will get you into the ER more. You will be being graded by attendings of whatever specialty you are actually rotating under (OB/Gyn, ortho, etc.) and they are generally not impressed by students who wound up on their service because of a longing to do EM. They will want you to be excited about the OB issues involved, not the EM issues and they'll want you to wet yourself with anticipation of taking a consult patient to the OR, not a desire to get back to the ED and do more consults. And even if you think you can pretend to be interesed in whatever for a month it is often easy to tell who is really into it and who isn't.

 

[Tiger26]

FWIW, I'm on a neurovascular rotation right now which is supposed to be the 'acute stroke team' that's really just the 'chronic medical management for people who've had strokes' team

In the description, it said there would be a lot of ED consults, but I've only went there once and we only have 1 day left.

I'd just be a little leery since you may be doing Ob/Gyn stuff all day with patients who initially happened to come through the ED

 

[docB]

FWIW, I'm on a neurovascular rotation right now which is supposed to be the 'acute stroke team' that's really just the 'chronic medical management for people who've had strokes' team

In the description, it said there would be a lot of ED consults, but I've only went there once and we only have 1 day left.

I'd just be a little leery since you may be doing Ob/Gyn stuff all day with patients who initially happened to come through the ED

That's a good point too. We would think of a "ED Consult service for specialty X" as being for patients with emergent issues complicated enough to warrant a consult (I know I did). The service may actually be for any patient that came in via the ED as opposed to the scheduled admits for elective surgeries. It may also be a euphemism for a dumping ground for the uninsured.

 

[peppy]

Personally, I think the best way to get a feel for the ER would be if you talked to some of the ER residents about if they mind if you shadow them on a few of your days off or something like that, to get a full sense of what the ER is truly like. In exchange, maybe you could offer to help them with their patients who require pelvics and rectals (since htat's what you'd be doing an awful lot of on the ob/gyn ER rotation anyway, and in my experience many ER residents love having a med student around to do that kind of thing for them 🙂 )

 

[docB]

Personally, I think the best way to get a feel for the ER would be if you talked to some of the ER residents about if they mind if you shadow them on a few of your days off or something like that, to get a full sense of what the ER is truly like. In exchange, maybe you could offer to help them with their patients who require pelvics and rectals (since htat's what you'd be doing an awful lot of on the ob/gyn ER rotation anyway, and in my experience many ER residents love having a med student around to do that kind of thing for them 🙂 )

I don't think this is a good idea. First off a resident can't OK someone to shadow them in the ED. That needs to be an attending who is aware of all the various responsibilities it entails (HIPAA, insurance, etc.). Second turfing a rectal or a pelvic to a student with no experience is inappropriate. We're doiing those exams for information right? If we send a rank novice in and accept their exam as definitive then we're gonna miss stuff. Brand new medstudents and inexperienced residents do exams under direct supervision and then those exams are repeated by a more experienced doc in many cases.

 

[peppy]

At my own hospital, it was allowed when a student dropped into the ED for a couple of days because he had nothing to do on his scheduled rotation, but I think some places are more relaxed about such things than others. As for the issue of whether students should be doing pelvics and rectals without the resident confirming their findings, well, I definitely agree that it might not be the best way to do things but I quickly learned on my EM rotations that a lot of residents do seem to like to use med students for this sort of "scut"/"learning experience" (depending on your perspective). Maybe the places I rotated at were exceptions, though!

 

[SanDiegoSOD]

Thanks for the advice everyone. An anesthesiology spot just opened up so I'm going to take that during winter break and will save EM for next June.

 

[docB]

Thanks for the advice everyone. An anesthesiology spot just opened up so I'm going to take that during winter break and will save EM for next June.

Cool. But, be careful. The gas guys hate nothing as much as EM people who just want to do tubes. They want you to be interested in anesthesiology. So ask about stuff that's applicable to both. Difficult airways, RSI and so on are always good. Hit them up about the stuff we are not so great on like pre tube evaluation of the airway, multi drug sedation regimens, etc.